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General NPI Number Information
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NPI Number | 1740314301
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Entity Type | Individual
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Provider Name | JUDITH CHARLOTTE CLINGMAN M.A, LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 19677 AQUA VIEW LN
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City | FORT MYERS
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State | FL
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Zip | 33913-9664
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Country | US
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Telephone | 310-749-2508
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Fax | 310-317-7878
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Provider Business Mailing Address
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Address Line | 19677 AQUA VIEW LN
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City | FORT MYERS
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State | FL
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Zip | 33913-9664
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Country | US
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Telephone | 310-749-2508
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Fax | 310-317-7878
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT36923
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License Number State | CA
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